Rapidly fatal tropical pyomyositis in an elderly diabetic woman

Necrotizing soft tissue infection, with or without myositis, is classified among the most dangerous infectious emergencies in clinical practice. The authors report a case of an older diabetic woman who presented to the orthopedic service with right elbow pain after a small trauma with skin abrasion and released with an analgesic prescription. After 48h, she presented to the emergency room with a history of developing bullous and necrotic lesions in the upper right limb, hypotension, and numbness, with rapid and fatal evolution despite adequate clinical and surgical therapeutic support. Muscle biopsy showed necrotizing myositis. Blood culture was positive for Panton-Valentine leukocidin producing (PVL-positive) methicillin-resistant S. aureus. Although PVL has a strong epidemiologic association with Community-Acquired Methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, it can also be found in CA-MSSA in the context of necrotizing pneumonia and skin and soft tissue infections. Although infrequent, CA-MRSA or CA-MSSA PVL+ infections should always be suspected in high-risk patients because they can rapidly evolve with severe, sometimes fatal complications.